Authors : Perry Hystad 1, MyLinh Duong 2, Michael Brauer 3, Andrew Larkin 1, Raphael Arku 4, Om P Kurmi 5, Wen Qi Fan 6, Alvaro Avezum 7, Igbal Azam 8, Jephat Chifamba 9, Antonio Dans 10, Johan L du Plessis 11, Rajeev Gupta 12, Rajesh Kumar 13, Fernando Lanas 14, Zhiguang Liu 15, Yin Lu 16, Patricio Lopez-Jaramillo 17, Prem Mony 18, Viswanathan Mohan 19, Deepa Mohan 19, Sanjeev Nair 20, Thandi Puoane 21, Omar Rahman 22, Ah Tse Lap 15, Yanga Wang 16, Li Wei 16, Karen Yeates 23, Sumathy Rangarajan 5, Koon Teo 5, Salim Yusuf 5,
Publication Year : 2019 May
Background: Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease.
Objectives: Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study.
Methods: We studied 91,350 adults 35–70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas.
Results: We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics.
Discussion: Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries.